Progression and Clinical Recurrence of Symptomatic Middle Cerebral Artery Stenosis (original) (raw)
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Six-month follow-up study in patients with symptomatic intracranial arterial stenosis
Journal of Clinical Neuroscience, 2006
Ischaemic stroke due to intracranial atherosclerosis is estimated to comprise 8-12% of all ischaemic strokes. It is known that the risk of recurrence is extremely high in patients with ischaemic stroke caused by intracranial stenosis. In the present study we aimed to evaluate the clinical and radiological findings over a 6-month follow-up period in patients with intracranial atherosclerosis. Prospective data for the ischaemic stroke patients admitted to our clinic between 2001 and 2004 were collected. The localization of stenosis/occlusion detected by magnetic resonance angiography (MRA) was recorded and patients were divided into two groups according to the presence of one or more arterial stenoses on MRA. The patients were followed up for 6 months at regular intervals and stroke recurrence and deaths were noted. Of the 47 patients, 11 had posterior circulation stenosis and 36 had anterior circulation stenosis. Thirty-three patients had only one intracranial artery stenosis, whereas 14 had more than one intracranial artery stenosis. Of the 38 patients who completed the 6month follow-up period, 13 had recurrent stroke, and 10 died. The rate of stroke recurrence in patients with intracranial artery stenosis may be higher than in patients with stroke due to other aetiologies, and stenosis of multiple intracranial arteries increases the rate of recurrence.
Australasian Radiology, 2000
Transcranial Doppler ultrasound (TCD) and computed tomography angiography (CTA) of 10 patients with middle cerebral artery territory stroke were studied. To obtain data from patients with presumed in situ middle cerebral artery (MCA) stenosis, the study excluded patients with a known source of cardiac emboli, significant carotid stenosis and classical lacunar syndrome. As the gold standard for this study, CTA demonstrated MCA stenosis in all patients (100%), while abnormal TCDs suggesting MCA stenoses were found in only six patients (60%). The stenotic sites differed among patients with normal and abnormal TCDs. Patients with false negative TCDs were found to have more distal lesions (distal M1 or M2 segment) whereas patients with TCD abnormalities tend to have more proximal lesions as demonstrated by CTA. It is concluded that an abnormal TCD is highly suggestive of stenosis of MCA. A normal TCD, however, does not exclude such a lesion, especially in patients with distal M1 or M2 stenoses. Therefore, TCD may not be the best screening test for intracranial vascular stenotic lesion in MCA territory stroke.
Impact of MCA stenosis on the early outcome in acute ischemic stroke patients
PloS one, 2017
Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively. Logistic regression analysis, Kaplan-Meier method and Cox proportional hazard model were applied to assess relevant variables between groups. Of 6003 patients, 23.3% had MCA stenosis, 10.1% ICA stenosis, and 3.9% both MCA and ICA stenosis. Patients with MCA stenosis had greater initial NIHSS, higher likelihood of stroke-in-evolution, and more severe disability than those without (all p<0.001). Patients ...
Management of Symptomatic Intracranial Atherosclerotic Stenosis
Current Treatment Options in Neurology, 2020
Purpose of review This review addresses the current evidence of epidemiologic and therapeutic strategies in patients with intracranial atherosclerotic stenosis (ICAS). Recent findings There is a considerable number of patients with ICAS worldwide, especially in Asia. Modern neuroimaging techniques have improved assessment lately and they are providing insight into ICAS-related mechanisms causing cerebrovascular ischaemic events. Several studies have investigated vascular risk factors for ICAS, primarily in Asians. Vascular risk factors not only facilitate the occurrence of ICAS, but their optimal management is linked to better outcome. Antithrombotic therapies also are a crucial prevention measure in these patients. Nevertheless, under best medical therapy, a considerable recurrence rate of cerebrovascular events has been reported. Thus, it has been investigated whether endovascular therapy or surgery are safe and beneficial options in patients with ICAS. In the future, optimal best medical therapy including novel drugs and careful patient selection for interventional therapy, differentiating the underlying pathophysiological mechanism of cerebrovascular ischaemic events and identifying characteristics of ICAS will be important. Improved endovascular devices and techniques might favour better outcome as well. Summary Current recommendations for therapeutic strategies in patients with ICAS include best medical therapy, optimal management of vascular risk factors and antithrombotic therapy. Endovascular and surgical therapy can be of benefit in selected patients.
Natural History of Stenosis From Intracranial Atherosclerosis by Serial Angiography
Stroke, 1998
Background and Purpose-Knowledge of the natural history of stenoses due to intracranial atherosclerosis may be useful for evaluating possible treatments such as angioplasty. Methods-We retrospectively reviewed records over a 7-year period to identify patients with intracranial atherosclerotic stenoses and serial angiograms. Quantitative measurements of stenoses were made in a blinded manner, and clinical outcomes were reviewed.
Neurological Sciences, 2014
Intracranial large artery stenosis and occlusion disease has been considered to be the cause of 8-10 % of ischaemic strokes in North America, and 30-50 % of strokes and more than 50 % of transient ischaemic attacks in Chinese population. So far we do not know the real prevalence of intracranial disease (ID) and the distribution of its risk factors in European population. We aimed to determine the prevalence and risk factors of ID in a European stroke population with computed tomography angiography (CTA). A retrospective study of consecutive ischaemic patients at the Stroke Unit of Utrecht, The Netherlands, from September 2006 to August 2008 was conducted. We assessed the presence of occlusion and/or stenosis of intracranial Internal Carotid Artery (ICA) and Middle Cerebral Artery on post-contrast 30-mm reconstruction axial CTA images. We analyzed the proportion of patients with ID, and the association of ID with risk factors and stroke subtype. In 220 patients (187 with stroke, 33 with TIA; mean age was 65 years, 57.3 % were male), intracranial stenosis was found in 6.4 % (95 % CI 3.9-10.4), intracranial occlusion in 34.5 % (95 % CI 28.6-41.0), and both occlusion and stenosis in 2.3 % (95 % CI 1.0-5.2). Multivariate analysis showed that the variables independently associated with ID were: extracranial ICA atherosclerosis (OR, 24.64;) and stroke subtypes TACS-PACS (OR, 7.61; 95 % CI 3.31-17.49). In conclusion, prevalence of intracranial stenosis in our study may well be consistent with previous observations in European and non-European population. ID may have been an underestimated condition in ischaemic Caucasian population.
African Journal of Neurological Sciences, 2020
Background and purpose Changes of the flow velocities of transcranial color coded duplex ultrasound (TCCD) in symptomatic middle cerebral artery (MCA) occlusive disease may be related to the occurrence of further vascular events after stroke. The objective of this study was to investigate the outcome and the prognosis of the MCA occlusive disease. Methods Initial TCCD was done to detect MCA stenosis or occlusion in patients with MCA territory infarction. We repeated TCCD examinations 3 months later and recorded any TIA, cerebral stroke or acute coronary syndrome events during this period. The changes of MCA flow velocities were categorized as normalized, regressive, persistent and progressive groups, according to the changes of MCA velocities at 3 months. Results We studied 31 patients with MCA territory infarction classified according to the initial TCCD results into normal MCA flow velocity group (15 patients), and abnormal MCA flow velocity group (16 patients). Eleven patients of the abnormal MCA group were re-evaluated by TCCD after 3 months as 5 patients died within the 3 months of the follow up. Two patients (18.2%) were normalized, 4 patients (36.4%) had persistent degree of stenosis, and 5 patients (45.5%) showed regression. The number of clinical events showed significant difference (p=0.037) between the normal and abnormal MCA groups. Only 1 patient (6.7%) of the normal MCA group had further cerebral stroke, while 7 patients (43.8%) of the abnormal MCA group suffered of further cerebral stroke. Conclusions Symptomatic MCA stenosis is associated with higher risk of recurrent cerebral stroke.